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CSAP Photovoice Project Narrative Introduction Photovoice is a process of putting camera in the hands of community members and allowing participatory needs assessment in a manner that expands the narrative of the participant by including the visual. As defined by the concept developers, Caroline C. Wang and Mary Ann Burris,
The CSAP Photovoice Project adapted the Photovoice concept to give a glimpse into the lives and communities of substance dependent adolescents receiving treatment services at a drug-free residential program in the State of Maryland. Conducted over a three-month period, the project was a rich learning opportunity for the facilitator and the participants. The process of the project was as important as the outcome. The Project The Catoctin Summit Adolescent Program (CSAP) is a drug-free residential facility for adolescents recovering from chemical dependency. The program is operated by the Washington County Health Department (WCHD) and located in Frederick County. Unique in its form and function, the program serves the State of Maryland and houses up to twenty-six (26) residents ages 14 to 18. Since its inception in 1987, the program has adapted and evolved to survive the ravages of limited funding, managed care and political fortunes. The program currently serves residents who have completed an Intermediate Care Facility (ICF) stay and who need continued support in their recovery. Average length of stay is four months. The residents participate in individual, group and family counseling (on weekends). CSAP‘s daily schedule includes academic and structured activities. For additional information, see Organizational chart of the WCHD Division of Addictions and Mental Health Services and the Brochure of CSAP services. Discussion of the project began in August 2000. Initial discussion of adapting Photovoice for CSAP considered conducting the project on-site. With the idea of community assessment in mind, allowing the residents to take cameras home over the four-day Christmas home pass seemed to be the best option. Planning the project took place in November with sessions beginning in December. See Schedule of Photovoice Sessions. At the project outset, the importance of project completion was discussed. As an educational participatory experience, the process was as critical as any outcome for both the project facilitator and the participants. Although target audiences for the completed project were identified, uncertainty existed about whether the project would come to fruition. Due to the nature of conducting the project with minors, it was necessary to secure parental consent for participants in the project. Packets were mailed to the parent/guardian(s) of record. The packets included a description of Photovoice obtained from the Internet website, letter of introduction, a copy of the Photovoice contract, consent for participation and a self-addressed, stamped envelope to return the consent. If written consent was not returned, evening staff called the guardian and secured verbal permission to participate. One family chose not to give consent based on their desire for privacy of their home. The anger of the adolescent toward his family for declining consent was addressed by clinical staff. Verbal consent was given in some cases, with guardians later returning written consent. In November, staff briefing took place. Some of the concerns raised by the clinical staff involved what residents would be doing on the home pass. Considerable effort had been made by the staff to have residents commit to avoiding “slippery places,” an addictions treatment reference to people, places and things associated with substance use. Staff were concerned that the project would encourage residents to take pictures of “slippery” environments. These concerns were addressed through discussion of safety issues. At the project outset, staff were supportive and interested. The project could not have been completed without the CSAP staff’s contribution to the project: suggestions, mailing and collecting parental consents, and encouraging participation in the project. CSAP’s teacher was an invaluable contribution of support. She agreed to permit residents to use school time to work on the project and agreed to provide credit in subject areas on an individual basis to project participants. At the outset of the project, the program coordinator suggested development of a feedback box for communication. One adolescent used the box to share her feelings about the project.Another forged derogatory comments and attributed the comments to another group member. The commentary box was under utilized in this project but would provide a mechanism of communication for participants of similar projects. Photovoice Groups CSAP is structured into two groups, A-side and B-side. All activities with these groups are conducted separately. A-side is characterized by more mature boys.B-side is characterized by girls and less mature boys. This arrangement promotes management of the facility and reduces sexual activity between the residents. Photovoice groups were developed for A-side and B-side. At the outset, Group A had seven participants, and Group B had seven participants. Participants were selected from the possible 26 residents by anticipated discharge date and willingness to participate in the project. Significantly a number of adolescents left the facility just prior to Christmas. Until near completion of the project, groups and activities were conducted separately. At the end of the project, four participants remained. The remaining Group A members had been moved to B-side and these participants completed the project together. Documentation One labor-intensive aspect of the project was the requirement of documentation of the participant’s activities in the individual records. As the project was considered an activity of the CSAP program, documentation requirements were dictated by the policy and procedures of the Division of Addictions and Mental Health Services. A distinct section of the consumer record was created under the Educational/Vocational flap. All project-related paperwork including contracts, correspondence and progress note pages were stored in the record. Time-oriented individual notes were written for each session of the project. Timeline and Attrition The facilitator’s schedule contributed to the timeline of the project occurring over a three-month period. A shorter timeline would be recommended for future projects of this nature. The project was entirely voluntary. At the outset of the third session a group phenomenon of attrition occurred with five (5) participants declining further participation. Reason for declining included an expressed desire to focus on family on home pass. As several participants had been in detention facilities prior to coming to CSAP, the home pass would be the first time they had been with their families in months. One participant declined further participation due to resistance to securing written release for individuals he photographed. Another participant failed to return his camera and two did not take any pictures while on pass. Two participants received their pictures but were unsuccessfully discharged from the facility prior to project completion. Attrition was an obstacle to project completion. The flexibility of the Photovoice concept allowed the project to be completed; however, there was a significant loss of group process. Remaining participants completed their contributions to the project working mostly independently. A shorter timeline may have helped reduce loss of participants and preserved more of the group process. Materials The project facilitator chose to use disposable cameras (27 exposure) with flash. Color film was used; however, one participant chose to convert all his pictures to black and white. The cameras were obtained on sale at a local retailer. The professional photographer enlisted as an outside resource stated that if the project was conducted again, he would assist with obtaining the cameras at cost. Planning future projects could make better use of outside resources for funding and materials. Disadvantages of the disposable cameras were the quality of the pictures and adjustment of the participants to the differential between the viewer and the image captured by the camera. As the timeline did not allow practice, pictures produced reflected a lot of images of fingers. This disadvantage was compensated by the use of photo-editing software to manipulate images. Take home packs consisted of
Photo development was completed at the local Wal-Mart. Both prints and digital CDs were obtained of the participants’ pictures. Participants were given an album with one set of prints. Participants could obtain additional prints to give to individuals they photographed if requested by them. Ethics and Safety The need for photo releases proved to be an obstacle for one participant. He chose not to participate due to his refusal to ask family and friends to sign a photo release. The facilitator emphasized the need for safety in the conduct of participants and in keeping with the concerns of CSAP staff, reinforced the message of avoiding slippery places. Fortunately all participants adhered to the project contract in this area. One participant was adamant about not having her pictures posted in any manner to the Internet. The facilitator agreed to honor this request whatever the ultimate end of the project might be. Use of Outside Resources One Photovoice session included presentation by a professional photographer. Kevin Gilbert of the Herald-Mail Company, Hagerstown, Maryland, came to present to the Photovoice participants. The use of an outside resource was an asset to the project. He was able to discuss photographic technique illustrated with examples of recent photo assignments for the newspaper. He discussed the role of the visual in media today, as well as aspects of a career in photojournalism. An interesting observation was that the more mature group of participants asked questions about technique and career, whereas the less mature group were focused on the content of the photographs. Notes About Technology Technology was both an asset and an obstacle to completion of the Photovoice Project. Use of computer photo-editing capabilities enhanced the project and enriched the experience of the participants. The participants were able to select and edit their pictures using the schoolroom computer. Support of CSAP’s teacher was a critical factor in project completion as she permitted participants to work on the project during designated school hours. The project facilitator’s learning curve was an obstacle at times. Variability in the “computerese” of the participants was also a difficulty. A recommendation for future projects that employ computer photo editing would be development of a tutorial on photo editing for the participants. At the project outset, the facilitator purchased The Print Shop Pro Publisher Version 11 by Broderbund. The software included Printshop PhotoPro 2.0 Express. Later, when the participants’ CDs were run in the school computers, Microsoft Picture It!ã installed automatically. The Picture It!ã Software is more complicated and contains more distracting features, i.e., the ability to create magazine covers. Relative merits of the PhotoPro 2.0 include ease of use, simplicity and creation of smaller picture files. A difficulty was that pictures edited with PhotoPro had to be converted for insertion into other applications. Although the Microsoft Picture It!ã Files imported into other applications with ease, the files were larger. A recommendation for future projects would be that specific photo-editing software be chosen and the participants given more instruction on its use. A challenge faced by the facilitator was being between access to computers during the project. Ideally, an application, i.e., Word or PowerPoint, would be used to print pages for participants to develop narratives for selected pictures. However, by the time that the facilitator was able to print slide pages for the participants, several had left the facility. Word pages would also have been an option at this point, and may have been less intimidating for participants with lower technological skills. Another obstacle was that of moving the completed PowerPoint presentation from computer to computer. The schoolroom computers had only one color printer and no CD-rom rewritable drive. For future projects, facilitators should consider the most effective use of available technological tools for project enhancement as part of the planning process. Themes Development One
session focused on themes development. A
recovery themes handout was developed to assist participants in identifying
themes for their pictures. Group
participants spent one session discussing themes. Themes generated were a rich
snapshot of the participants’ lives and worldview.
Although the themes generated may not be representative of all chemically
dependent adolescents, key determinants of adolescent substance use/abuse are
reflected in the contribution of participants. Recovery Themes for Photovoice – Group A 1.
When I think about not using alcohol and other drug, I think about: 2.
When I picture home, I think of: 3.
What I am looking forward to during Christmas pass: 4.
What will be hard for me when I go home is: 5.
What is good about recovery is: 6.
What will be hard for me in recovery is: 7.
My supports in recovery are: Recovery Themes for Photovoice – Group B 1.
When I think about not using alcohol and other drug, I think about: 2.
When I picture home, I think of: 3.
What I am looking forward to during Christmas pass: 4.
What will be hard for me when I go home is: 5.
What is good about recovery is: 6.
What will be hard for me in recovery is: 7.
My supports in recovery are: Outcomes The project timeline did not permit research into the actual outcomes for the participants. Future projects might include some type of outcome evaluation. Observation of the facilitator was that the process of the project was as important as the outcome. Future projects might include session evaluation. One obstacle might be the burden of paperwork on the participants. A valuable outcome was the exposure of the participants to photography, computer technology and photo editing. Discussion The CSAP Photovoice Project demonstrates the adaptability of the Photovoice concept to a unique residential setting. The project represented a valuable learning experience for the facilitator and was an opportunity for exposure to new experiences for the participants. The project identifies some difficulties encountered when working with adolescents, particularly substance involved youth. Attrition was an obstacle to group process due to loss of interest, competing priorities and behavior disturbances. However the completed project demonstrates aspects of the worldview of substance dependent adolescents in a unique personalized manner, which should heighten awareness of interested stakeholders of their needs. The Photovoice project illuminates several factors relevant to adolescent treatment. Evident in the photographs produced by the participants are aspects of their lives that are important to them. The critical influence of peers is present as most of the participants took pictures of their friends. The crucial influence of family is apparent. All of the participants included discussion of family in themes development and most included them in their pictures. This points to the need for adolescent treatment programs to develop strong family therapy components. Themes of death and loss that run through the participant’s lives are also apparent. Of note, several participants took pictures of places that friends and relatives had been killed. Grief therapy may be a significant need of adolescents in treatment today. Although only four participants completed work on the project, the outcome is a highly personalized presentation of the world of substance dependent adolescents. The facilitator hopes that the project will eventually find an audience, and perhaps break ground for future projects of this nature. References http://www.Photovoice.com Accessed from the World Wide Web November 15, 2000.
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Communication Strategies for Health Education and Health Promotion |